Poor Asthma Control in the United States

Asthma is a common pulmonary disorder: affecting about 10% of children and 8 % of adults. Previously, I discussed in Doctor’s Orders, the correlation between not using an asthma controller medication (an inhaled corticosteroid) and risk for asthma attacks. In a recently published article (Colice GL et al. The CHOICE Survey: High Rates of Persistent and Uncontrolled Asthma in the US. Ann Allergy Asthma Immunol, 2012; 108:157-162), the authors found that asthma management in the United States falls short of the nationally-recognized asthma targets.

CHOICE (Comprehensive Survey of Healthcare Professionals and Asthma Patients Offering Insight on Current Treatment Gaps and Emerging Device Options) was designed to evaluate the use of inhaler devices for asthma, but also questioned asthma severity and control. Of 1000 adolescent and adult asthmatics, almost half (49%) were not using any asthma controller medication. Of concern is that 47% with mild or moderate persistent asthma and 32% with severe persistent asthma were not taking a controller medication. In other words, almost 4 out of 5 asthmatics with persistent disease were not taking a controller for their asthma!

To add insult to injury, of those asthmatics who were not taking a controller medication, 64.5% thought that their asthma was either completely or well controlled. Of this group not taking controller medication, however, 7.1% had a hospitalization, 12.9% had an emergency room visit, and 17.1% had an unscheduled doctor’s office visit for asthma in the previous year.

Of the asthmatics taking controller medication, 45.3% were not well controlled and 40.4% were very poorly controlled. Only one in seven asthmatics who reported using controller medication were actually well controlled. Those on controller medication but with not-well or poorly controlled asthma also had a higher incidence of hospitalization, ER visits or unscheduled doctor’s office visits for their asthma over the prior 12 months.

Asthma control also had a bearing on quality of life. Those asthmatics with severe persistent disease or with very poorly controlled asthma reported higher rates of emotional issues, such as depression, fatigue and loneliness.

In summary, asthma management falls short of national targets. Also, the poorer the asthma control, the higher the chance of requiring acute medical care (and increased healthcare cost) for asthma and the poorer the quality of life. These data suggest that many patients with asthma should be on daily controller medication and that those on long-term controllers are often not adequately controlled. Go see your asthma specialist!